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EDITORIAL |
COBRA combination therapy in daily practice—getting back to the future
Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, PK 6 Z 165, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
Correspondence to: M. Boers. E-mail: keb.info@vumc.nl
| The first 10% of the full text of this article appears below. |
The COBRA trial published in 1997 was among the first to prove the worth of ‘reversing the pyramid strategy’ in the treatment of rheumatoid arthritis (RA) [1]. This pyramid from the fifties offered most effective treatment as late as possible, under the false assumption that RA was in most cases a self-limiting disease, and that treatment was mostly toxic and did more harm than good. Wilske and Healey [2] attacked the pyramid approach in an editorial in 1990, suggesting treatment should be aimed at achieving disease control early.
The COBRA strategy was novel in two ways: first, it combined the drugs